It is always better to prevent a pressure ulcer rather than treat one. Pressure ulcers take weeks or months to heal, causing pain and further reducing function for many people with limited mobility, including veterans with spinal cord injury (SCI) and the elderly. Techniques to reduce pressure ulcers include cushions which improve regional pressure distribution. Many studies have shown that although no single cushion can meet every user's need, a pressure relieving cushion is a critical component in all wheelchair seating systems. An appropriate wheelchair cushion can maximize function for individuals with mobility restrictions and decrease the risk of pressure ulcer development. The provision of suitable cushions is a very important part of any pressure ulcer prevention program. The proposed pilot study will develop and test a prototype cushion that uses advanced dynamic materials to create a modular support device. The unique modular design of this system has two advantages; firstly each cushion can be customized for individual seating requirements at very low cost. Secondly, since cushions components are removable, the cushion can be repaired rather than replaced, thus increasing durability. Prototype modular cushions using a range of gel balls will be constructed and the physical properties evaluated following ISO 16840-2 guidelines to determine loading characteristics under standardized seating test protocols. A thermodynamic rigid cushion loading indenter (TRCLI) will be used to evaluate the cushion microenvironment under load. Interface pressures distributions will also be measured using the CONFORMat pressure mapping system. Standard high-performance cushions will be used as controls and tested using the same protocol. Durability testing will be carried out following ISO 16840-3 guidelines to simulate daily use for one year. A cost analysis will be carried out to make sure that our cushion will be low-cost as well as high performance. Clinical personnel and wheelchair users will be involved throughout the study to ensure that the modular cushion will achieve high acceptance in clinical care. PUBLIC HEALTH RELEVANCE: Excellence in care is an important mission of the VA. Pressure ulcers are a leading cause of re-hospitalization for many veterans with long-term disability, particularly those with limited or restricted mobility. Techniques to reduce pressure ulcers include pressure relieving cushions. Although no single cushion can meet every user's need, a pressure-relieving cushion is a critical component in all wheelchair seating systems. Our preliminary work has shown that that high-performance gel filled polymer spheres can be incorporated into a low-cost modular cushion design, which has the potential to provide both pressure relief and postural stability. Systematic biomechanical assessment of the modular cushion design in the proposed pilot study will provide the information needed to develop the cushion for evaluation in a clinical pilot study. The project will enhance health care provision for veterans, allowing them to benefit from the use of advanced technology to develop a low-cost high performance cushion for effective pressure relief.